Affective Disorders Among Elderly General Practice Patients

1994 ◽  
Vol 165 (4) ◽  
pp. 533-537 ◽  
Author(s):  
C. Turrina ◽  
R. Caruso ◽  
R. Este ◽  
F. Lucchi ◽  
G. Fazzari ◽  
...  
Keyword(s):  
General Practice ◽  
Major Depression ◽  
Elderly Patients ◽  
General Practitioners ◽  
Affective Disorders ◽  
Dysthymic Disorder ◽  
Not Otherwise Specified ◽  
Prevalence Of Depression ◽  
General Practices

BackgroundWe investigated the prevalence of depression among 255 elderly general practice patients and the practitioners' performance in identifying depression.MethodElderly patients attending 14 general practices entered a screening phase with GHQ-12 and MMSE. Those positive were then interviewed with GMS and HAS.ResultsDSM-III-R major depression affected 22.4%, dysthymic disorder 6.3%, not otherwise specified (n.o.s.) depression 7.1 %. General practitioners performed fairly well: identification index 88.4%, accuracy 0.49, bias 1.85.ConclusionsDepression was markedly high. A selective progression of depressed elderly from the community to general practitioners is implied.

scholarly journals ‘Motivational work’: a qualitative study of preventive health dialogues in general practice

2020 ◽  
Vol 21 (1) ◽  
Author(s):  
Marie Broholm-Jørgensen ◽  
Siff Monrad Langkilde ◽  
Tine Tjørnhøj-Thomsen ◽  
Pia Vivian Pedersen
Keyword(s):  
General Practice ◽  
General Practitioners ◽  
Support System ◽  
Preventive Intervention ◽  
Digital Health ◽  
Clinical Encounter ◽  
Preventive Health ◽  
Structured Interviews ◽  
General Practices ◽  
Municipal Health

Abstract Background The aim of this article is to explore preventive health dialogues in general practice in the context of a pilot study of a Danish primary preventive intervention ‘TOF’ (a Danish acronym for ‘Early Detection and Prevention’) carried out in 2016. The intervention consisted of 1) a stratification of patients into one of four groups, 2) a digital support system for both general practitioners and patients, 3) an individual digital health profile for each patient, and 4) targeted preventive services in either general practice or a municipal health center. Methods The empirical material in this study was obtained through 10 observations of preventive health dialogues conducted in general practices and 18 semi-structured interviews with patients and general practitioners. We used the concept of ‘motivational work’ as an analytical lens for understanding preventive health dialogues in general practice from the perspectives of both general practitioners and patients. Results While the health dialogues in TOF sought to reveal patients’ motivations, understandings, and priorities related to health behavior, we find that the dialogues were treatment-oriented and structured around biomedical facts, numeric standards, and risk factor guidance. Overall, we find that numeric standards and quantification of motivation lessens the dialogue and interaction between General Practitioner and patient and that contextual factors relating to the intervention framework, such as a digital support system, the general practitioners’ perceptions of their professional position as well as the patients’ understanding of prevention —in an interplay—diminished the motivational work carried out in the health dialogues. Conclusion The findings show that the influence of different kinds of context adds to the complexity of prevention in the clinical encounter which help to explain why motivational work is difficult in general practice.

Adoption of ICT in Rural Medical General Practices in Australia

2012 ◽  
pp. 40-51 ◽  
Author(s):  
Patricia Deering ◽  
Arthur Tatnall ◽  
Stephen Burgess
Keyword(s):  
General Practice ◽  
General Practitioners ◽  
Network Theory ◽  
Medical Records ◽  
Actor Network Theory ◽  
Actor Network ◽  
Its Analysis ◽  
General Practices ◽  
Suitable Framework

ICT has been used in medical General Practice throughout Australia now for some years, but although most General Practices make use of ICT for administrative purposes such as billing, prescribing and medical records, many individual General Practitioners themselves do not make full use of these ICT systems for clinical purposes. The decisions taken in the adoption of ICT in general practice are very complex, and involve many actors, both human and non-human. This means that actor-network theory offers a most suitable framework for its analysis. This article investigates how GPs in a rural Division of General Practice not far from Melbourne considered the adoption and use of ICT. The study reported in the article shows that, rather than characteristics of the technology itself, it is often seemingly unimportant human issues that determine if and how ICT is used in General Practice.

scholarly journals Repeat prescribing policy in New Zealand general practice: making it better

2020 ◽  
Vol 12 (4) ◽  
pp. 373
Author(s):  
Steven Lillis ◽  
Liza Lack
Keyword(s):  
General Practice ◽  
New Zealand ◽  
General Practitioners ◽  
Local Development ◽  
Policy Research ◽  
Practice Research ◽  
Annual Conference ◽  
Protected Time ◽  
Repeat Prescribing ◽  
General Practices

ABSTRACT INTRODUCTIONRepeat prescribing is common in New Zealand general practice. Research also suggests that repeat prescribing is a process prone to error. All New Zealand general practices have to comply with requirements to have a repeat prescribing policy, with the details of the policy to be designed by the practice. AIMTo inform the development of practice policy, research was undertaken with experienced general practitioners to identify and mitigate risk in the process. METHODSAt the 2019 annual conference of the Royal New Zealand College of General Practitioners, a workshop was held with 58 experienced general practitioner participants. The group was divided into six small groups, each with the task of discussing one aspect of the repeat prescribing process. The results were then discussed with the whole group and key discussion points were transcribed and analysed. RESULTSIssues identified included: improving patient education on appropriateness of repeat prescribing; having protected time for medicine reconciliation and the task of repeat prescribing; reducing the number of personnel and steps in the process; and clarity over responsibility for repeat prescribing. DISCUSSIONThis research can inform the local development of a repeat prescribing policy at the practice level or be used to critique existing practice policies. Attention was also drawn to the increasing administrative burden that repeat prescribing contributes to in general practice.

Problems with Recruitment in a Randomized Controlled Trial of Counselling in General Practice: Causes and Implications

1996 ◽  
Vol 1 (2) ◽  
pp. 77-80 ◽  
Author(s):  
Karen Fairhurst ◽  
Christopher Dowrick
Keyword(s):  
General Practice ◽  
Randomized Controlled Trial ◽  
General Practitioners ◽  
Controlled Trial ◽  
Psychiatric Morbidity ◽  
Family Health ◽  
Telephone Interviews ◽  
Randomized Controlled ◽  
Authority Area ◽  
General Practices

Objectives: To evaluate the effectiveness of counselling in the management of minor psychiatric morbidity in general practice, and to explore the reasons for difficulties in recruiting patients to such an evaluation. Methods: We attempted to conduct a randomized controlled trial of counselling in eight general practices in one NHS family health services authority area in England. Having experienced significant problems recruiting patients, we conducted semi-structured telephone interviews ( n = 8) with participating GPs to explore the reasons for these difficulties. Results: Five months after the start of the study only one patient had been recruited. The main reasons identified as contributing to the recruitment problems were: General practitioners' motivation for involvement in the study; their ethical doubts about the randomization process; the perceived lack of a viable non-counselling intervention; and their existing practical commitment to counselling. Conclusion: Although methodological modification might enhance the potential for success in future studies of this sort, more fundamental difficulties concerning general practitioners' attitudes to research and their professional responsibilities lie at the heart of our recruitment problems.

scholarly journals ‘Motivational work’: a qualitative study of preventive health dialogues in general practice

2020 ◽  
Author(s):  
Marie Broholm-Jørgensen ◽  
Siff Monrad Langkilde ◽  
Tine Tjørnhøj-Thomsen ◽  
Pia Vivian Pedersen
Keyword(s):  
General Practice ◽  
General Practitioners ◽  
Support System ◽  
Preventive Intervention ◽  
Digital Health ◽  
Clinical Encounter ◽  
Preventive Health ◽  
Structured Interviews ◽  
General Practices ◽  
Municipal Health

Abstract Background The aim of this article is to explore preventive health dialogues in general practice in the context of a pilot study of a Danish primary preventive intervention ‘TOF’ (a Danish acronym for ‘Early Detection and Prevention’) carried out in 2016. The intervention consisted of 1) a stratification of patients into one of four groups, 2) a digital support system for both general practitioners and patients, 3) an individual digital health profile for each patient, and 4) targeted preventive services in either general practice or a municipal health center.Methods The empirical material in this study was obtained through 10 observations of preventive health dialogues conducted in general practices and 18 semi-structured interviews with patients and general practitioners. We used the concept of ‘motivational work’ as an analytical lens for understanding preventive health dialogues in general practice from the perspectives of both general practitioners and patients.Results While the health dialogues in TOF sought to reveal patients’ motivations, understandings, and priorities related to health behavior, we find that the dialogues were treatment-oriented and structured around biomedical facts, numeric standards, and risk factor guidance. Overall, we find that numeric standards and quantification of motivation lessens the dialogue and interaction between GP and patient and that contextual factors relating to the intervention framework, such as a digital support system, the general practitioners’ perceptions of their professional position as well as the patients’ understanding of prevention —in an interplay—diminished the motivational work carried out in the health dialogues.Conclusion The findings show that the influence of different kinds of context adds to the complexity of prevention in the clinical encounter which help to explain why motivational work is difficult in general practice.

scholarly journals Lithium monitoring in hospital and general practice

1997 ◽  
Vol 21 (9) ◽  
pp. 570-572 ◽  
Author(s):  
Ann Ryman
Keyword(s):  
General Practice ◽  
General Hospital ◽  
General Practitioners ◽  
Thyroid Function ◽  
Current Practice ◽  
General Practices

A survey of the current practice of lithium monitoring in a general hospital and the general practices it serves revealed erratic and infrequent assessments of serum lithium levels and also of renal and thyroid function. General practitioners, who in this study monitor approximately a third of the patients on lithium, performed worse than psychiatrists, but in neither case was there cause for complacency.

Test-Characteristics of the GDS-15 in Screening for Major Depression in Elderly Patients in General Practice

2006 ◽  
Vol 29 (1) ◽  
pp. 1-9 ◽  
Author(s):  
Dick Bijl ◽  
Harm WJ. van Marwijk ◽  
Hermanz J. Adér ◽  
Aartjan T.F. Beekman ◽  
Marten de Haan
Keyword(s):  
General Practice ◽  
Major Depression ◽  
Elderly Patients ◽  
Test Characteristics

scholarly journals Emergence of a Novel Coronavirus (COVID-19): Protocol for Extending Surveillance Used by the Royal College of General Practitioners Research and Surveillance Centre and Public Health England (Preprint)

2020 ◽  
Author(s):  
Simon de Lusignan ◽  
Jamie Lopez Bernal ◽  
Maria Zambon ◽  
Oluwafunmi Akinyemi ◽  
Gayatri Amirthalingam ◽  
...  
Keyword(s):  
Public Health ◽  
General Practice ◽  
General Practitioners ◽  
Royal College ◽  
Medical Records ◽  
Influenza Surveillance ◽  
General Practices ◽  
New Codes ◽  
Containment Policy ◽  
Tract Infections

BACKGROUND The Royal College of General Practitioners (RCGP) Research and Surveillance Centre (RSC) and Public Health England (PHE) have successfully worked together on the surveillance of influenza and other infectious diseases for over 50 years, including three previous pandemics. With the emergence of the international outbreak of the coronavirus infection (COVID-19), a UK national approach to containment has been established to test people suspected of exposure to COVID-19. At the same time and separately, the RCGP RSC’s surveillance has been extended to monitor the temporal and geographical distribution of COVID-19 infection in the community as well as assess the effectiveness of the containment strategy. OBJECTIVE The aim of this study is the surveillance of COVID-19 in both asymptomatic populations and ambulatory cases with respiratory infections to ascertain both the rate and pattern of COVID-19 spread and to assess the effectiveness of the containment policy. METHODS The RCGP RSC, a network of over 500 general practices in England, extract pseudonymized data weekly. This extended surveillance comprises of five components: (1) Recording in medical records of anyone suspected to have or who has been exposed to COVID-19. Computerized medical records suppliers have within a week of request created new codes to support this. (2) Extension of current virological surveillance and testing people with influenza-like illness or lower respiratory tract infections (LRTI)—with the caveat that people suspected to have or who have been exposed to COVID-19 should be referred to the national containment pathway and not seen in primary care. (3) Serology sample collection across all age groups. This will be an extra blood sample taken from people who are attending their general practice for a scheduled blood test. The 100 general practices currently undertaking annual influenza virology surveillance will be involved in the extended virological and serological surveillance. (4) Collecting convalescent serum samples. (5) Data curation. We have the opportunity to escalate the data extraction to twice weekly if needed. Swabs and sera will be analyzed in PHE reference laboratories. RESULTS General practice clinical system providers have introduced an emergency new set of clinical codes to support COVID-19 surveillance. Additionally, practices participating in current virology surveillance are now taking samples for COVID-19 surveillance from low-risk patients presenting with LRTIs. Within the first 2 weeks of setup of this surveillance, we have identified 3 cases: 1 through the new coding system, the other 2 through the extended virology sampling. CONCLUSIONS We have rapidly converted the established national RCGP RSC influenza surveillance system into one that can test the effectiveness of the COVID-19 containment policy. The extended surveillance has already seen the use of new codes with 3 cases reported. Rapid sharing of this protocol should enable scientific critique and shared learning. INTERNATIONAL REGISTERED REPORT DERR1-10.2196/18606

scholarly journals General practitioners’ experiences with, views of, and attitudes towards, general practice-based pharmacists: a cross-sectional survey

2022 ◽  
Vol 23 (1) ◽  
Author(s):  
Ameerah S. Hasan Ibrahim ◽  
Heather E. Barry ◽  
Carmel M. Hughes
Keyword(s):  
General Practice ◽  
General Practitioners ◽  
Positive Impact ◽  
Clinical Skills ◽  
Community Pharmacists ◽  
Free Text ◽  
Full Time ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
General Practices

Abstract Background There is limited United Kingdom (UK) literature on general practice-based pharmacists’ (PBPs’) role evolution and few studies have explored general practitioners’ (GPs’) experiences on pharmacist integration into general practice. Therefore, this study aimed to investigate GPs’ experiences with, views of, and attitudes towards PBPs in Northern Ireland (NI). Methods A paper-based self-administered questionnaire comprising four sections was mailed in 2019 to 329 general practices across NI and was completed by one GP in every practice who had most contact with the PBP. Descriptive analyses were used and responses to open-ended questions were analysed thematically. Results The response rate was 61.7% (203/329). There was at least one PBP per general practice. All GPs had face-to-face meetings with PBPs, with three-quarters (78.7%, n = 159) meeting with the PBP more than once a week. Approximately two-thirds of GPs (62.4%, n = 126) reported that PBPs were qualified as independent prescribers, and 76.2% of these (n = 96/126) indicated that prescribers were currently prescribing for patients. The majority of GPs reported that PBPs always/very often had the required clinical skills (83.6%, n = 162) and knowledge (87.0%, n = 167) to provide safe and effective care for patients. However, 31.1% (n = 61) stated that PBPs only sometimes had the confidence to make clinical decisions. The majority of GPs (> 85%) displayed largely positive attitudes towards collaboration with PBPs. Most GPs agreed/strongly agreed that PBPs will have a positive impact on patient outcomes (95.0%, n = 192) and can provide a better link between general practices and community pharmacists (96.1%, n = 194). However, 24.8% of GPs (n = 50) were unclear if the PBP role moved community pharmacists to the periphery of the primary care team. An evaluation of the free-text comments indicated that GPs were in favour of more PBP sessions and full-time posts. Conclusion Most GPs had positive views of, and attitudes towards, PBPs. The findings may have implications for future developments in order to extend integration of PBPs within general practice, including the enhancement of training in clinical skills and decision-making. Exploring PBPs’, community pharmacists’ and patients’ views of this role in general practice is required to corroborate study findings.

Long-Term Prognosis of Major Depression in Old Age: A Comparison With Prognosis of Dysthymic Disorder

1995 ◽  
Vol 7 (S1) ◽  
pp. 69-82 ◽  
Author(s):  
Sirkka-Liisa Kivelä
Keyword(s):  
Major Depression ◽  
Clinical Outcome ◽  
Elderly Patients ◽  
Poor Prognosis ◽  
Sexual Interest ◽  
Age Groups ◽  
Dysthymic Disorder ◽  
Long Term Prognosis ◽  
Two Age Groups

The 5-year prognosis of 42 elderly patients with major depression (mean age 73.2 ± 6.3 years for men and 73.0 ± 7.3 years for women) is described. Furthermore, the clinical outcome of elderly patients with major depression is compared to that of 199 elderly patients with dysthymic disorder (mean age 69.6 ± 7.2 years for men and 71.3 ± 7.7 years for women) described in a previous article.Twelve percent of patients with major depression recovered, 26% still had depression after 5 years, 12% had possible dementia, 45% had died, and 5% could not be contacted. The outcome did not significantly differ between the sexes or the two age groups (65–74 and 75+). A poor clinical outcome of patients with major depression was related to a greater number of diagnosed diseases, strong feelings of restlessness, and higher sexual interest at the beginning of the follow-up. A poor prognosis was also found for the patients whose functional abilities and hobby activities declined during the follow-up. A poor prognosis tended to be related to absence of hypertension, frequent trembling of hands, low activity in listening to music, and high activity in watching TV at the onset, and to absence of malignant disease and occurrence of a high number of negative and positive life events during the follow-up period.Thirty-six percent of dysthymic patients recovered, 26% still had depression after 5 years, 9% had possible dementia, 25% had died and 4% could not be contacted. The outcome of dysthymic patients did not significantly differ between the sexes or the two age groups (65–74 and 75+). The clinical outcome of dysthymic patients tended to be more favorable than that of patients with major depression. The factors related to a poor outcome differed between patients with major depression and dysthymic patients.

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